Cuadernos de Bioetica最新文献

In 2008 Ingmar Persson and Julian Savulescu published an article arguing for the need to biotechnologically enhance moral capacities in order to address the risks implicit in the development of cognitive enhancements. In their view, the more individuals are intellectually enhanced, the greater the possibility of causing harm. To balance this risk, cognitive enhancement must be accompanied by moral enhancement (genetic, pharmacological or cybernetic) that extends to the entire population. This thesis has been made explicit over time in various works, in dialogue with other experts. This paper explores the development of this argument in contrast to later criticisms, as well as responses from Persson and Savulescu. Finally, it raises three problematic issues in the development of the above argument, around the following areas: (a) the difference between cognitive and moral enhancements; (b) the merely biological character of human nature; and (c) the relationship between human freedom and the notion of ″moral enhancement″ employed by the authors.

The concept of natural death has been present in philosophical, medical and social reflection for centuries, fulfilling a double function: understanding human finitude and hoping for a desirable way to reach the end of our days. Today, those goals have been blurred by the sense of control over death that comes from the high technology of medicine, the dreams of immortality nurtured by the media, and the confusing line drawn between autonomy and dignity. This article studies the concept of natural death that in the past 20th century was the subject of debate between health workers and bioethicists and that at the beginning of this 21st century has already begun to be questioned. The ″naturalness″ of death was intended to be a kind of ethical frontier in the face of any form of violence, injustice, excessive technicalization or interference with the human will. Today, many of these aspects are blurred in a context as unnatural as he hospital one. In addition, the forensic field has also encountered serious difficulties in excluding any human, voluntary or involuntary intervention, in a large part of the deaths, since there is little natural in what we breathe, eat or drink. Based on all this, a redefinition proposal is offered that responds to a double need: the social need to integrate the inevitable mortality and the shared personal need to reach the end after a humanizing process that excludes all human responsibility. It is anthropologically possible and ethically desirable natural death.

Legal duties of information, obtaining consent, confidentiality and protection of patient's privacy must be scrupulously fulfilled. However, Medical Ethics and Deontology impose a higher level of requirement on the doctor-patient relationship, namely, to adapt these duties to the specific patient and the specific situation. This means individualizing the medical act and making it absolutely personal; personalization in the doctor-patient relationship makes it unique and excellent, the moral objective of the medical profession from the Hippocratic precepts to the present day.

Those who knew Prof. Gonzalo Herranz Rodríguez share a common feeling in which respect and admiration are intermingled, transmitted from a natural and simple personality. He generated a remarkable capacity for attraction. In the broad field of bioethics he has left an indelible example of passionate and tenacious defence of scientific truth, both in the multiple facets that mark the daily life of medical action with respect to the sick, and in his clear international leadership when it was necessary to point out where authenticity was to be found in the biological findings on the first stages of the human embryo that later enable correct medical action to be guaranteed. His tenacious effort in the search for scientific truth, together with his defence of an attitude of closeness and humanity towards the patient, stemmed both from his rigour in the study of illness and his gifts of fine observation that allowed him to find solutions, a mixture of science and humanity, to the thousand incidences of medical action. For this reason, it is necessary to disseminate his work, as it constitutes a reference that marks the level of quality that is required for correct medical action.

Since the beginning of the commercialization, in 1960, of combined estrogen-progestin hormonal contraceptives (CHCs), their use has become widespread for other non-contraceptive indications: dysmenorrhea, irregular cycle length, hypermenorrhea and acne, among others (Lete, 2009; Barranco, 2016). In all cases, these are mild pathologies or minor symptoms for which there are effective therapeutic alternatives. Millions of women in the world receive this treatment, which acts by inhibiting the hypothalamic-pituitary-ovarian hormonal axis (HHO Axis), the central axis and regulator of the entire sexual and reproductive physiology of women. Despite the existence of an enormous number of women subjected to this inhibition (ACHs are currently used by some 214 million women around the world, with an annual market of close to 18 billion dollars), very little research has been done on the consequences of suppressing the HHO axis. Only in recent years, and in parallel to the demonstration of the existence of functional receptors for gonadotropins at different levels in the central and peripheral nervous systems, have publications on the neuropsychological effects of HCAs begun to appear. It is also striking that, despite being the most widely used drugs and for the longest time for the treatment of functional gynecological disorders, their use is outside the technical data sheet (i.e., they are used for purposes other than those listed in the official indication approved in their technical data sheet and which appear in the package insert). Although the use of these hormonal products causes a wide variety of side effects, which have been widely studied in the medical literature, the present study proposes, after an exposition of the different aspects of the use of HCAs, a detailed review of the available literature on the neuropsychological effects due to the annulment of the HHO axis. This in order to, after a biological analysis, subsequently establish whether there is an ethical appropriateness in the use that concerns us.

Nowadays, medicine tends towards specialization. But there are also more shared or interdisciplinary processes in which professionals request some type of technique or a diagnostic or therapeutic procedure that must performed by another specialist. In this scenario that involves different professionals, it is reasonable a certain debate about which of them should obtain the informed consent of the patient. The first error would be to pose this process as a confrontation between professionals who derive or delegate their own responsibilities to another. It is, on the contrary, a teamwork and not a mere delegation of duties. On the one hand, it should be the doctor who carries out the technique and, therefore, knows it best as a procedure and is an expert in the early diagnosis and management of side effects, who should inform about the procedure and its risks. And, therefore, it is his duty to obtain the appropriate informed consent. And, since everything is understood as a shared process, it would also be advisable that the physician in charge of the care and follow-up of the patient, and who has taken the initiative to request this technique, had already provided basic information, more focused on the reason for the indication, and that a pre-consent had been obtained, that is a prior elementary verbal consent of acceptance or, at least, of non-rejection. And it would be convenient to record this information in the medical record as well.

Renal dysfunction is common and can be severe in patients requiring cardiac surgery. There is currently a growing international interest in the declaration of Safe Health Units, around the safety of the surgical patient. This interest is influenced at the same time by utilitarianism and the defense of the great value of human life. The general objective was to analyze, from the bioethics of health care and the contents of surgical patient safety, acute kidney injury associated with cardiac surgery. A systematic review was carried out using the PRISMA methodology in PubMed databases with articles published in the last five years. The pathophysiology of the entity studied is complex and still poorly understood. In this period, there was a great interest in investigating acute kidney injury associated with cardiac surgery, however, no other studies were found that addressed this issue from a personalist bioethical approach. High scientific quality and methodological rigor were found in the included studies, assessed by the predominance of systematic reviews, meta-analyses, and multicenter, randomized, double-blind controlled studies. An interesting and novel field is initiated, which facilitates, from perspectives with a comprehensive and more humane assessment, decision-making on acute kidney injury associated with cardiac surgery.

It seems beyond doubt that the practice of certain sports requires gender differentiation, given the sexlinked characteristics that determine different levels of performance and skills. Moreover, there is a consensus on condemning doping practices, such as attempts to artificially alter the physical performance of athletes through the use of certain substances, because they involve tampering with the physical or mental conditions of the persons involved, as well as practices that have health risks, with consequences that can become serious and irreversible. In the case of ″trans″ athletes, their genetics, physiology, and endocrine system, responsible for typically male testosterone levels, would provide an insurmountable barrier to their eligibility in female athletic competition. However, the case of athletes diagnosed with Disorders of Sex Development does not fit into any of the above scenarios. They are biologically women and competes in the female category. They have not taken any anabolic substances that may be considered doping. We propose a bioethical evaluation of these cases.

This article aims to explore the bioethical problems that are concentrated around the Umbilical Cord Blood. The publication in the year 2020 in Spain of the new National Umbilical Cord Blood Plan recalls the current status of the issue. The bioethical problems of umbilical cord blood have not been specially studied, rather there are few studies in this regard and above all they have focused on the controversy over its autologous use and its storage in private banks. This work, the result of reading twenty-six institutional statements from the most diverse institutions in different countries, offers a detailed and systematic enumeration of the bioethical problems that arise around the life of umbilical cord blood and proposes, fundamentally, a classification with an evolutionary criterion, that is, following the course of the Umbilical Cord Blood, from its donation to its use, passing through the problems of donors and storage. The sources used cover a period from 1998 to 2019 and are practically all the existing ones. This work offers a conclusive analysis of a synchronic nature, in which the bioethical constants are detected in the 31 years analyzed, specifically the principles of autonomy and solidarity, in addition to the so-called bioethics of expectations; and another of a diachronic nature in which the bioethical nuclei in which the questions are concentrated stand out: the lack of personalistic principles and the conflict between freedom and solidarity.